Association Between Fibrinolysis Products and Platelet Activity in Patients with Acute Type A Aortic Dissection: A single-centre observational study

Background Acute type A aortic dissection (ATAAD) is a highly lethal cardiovascular emergency in which platelet dysfunction plays a pivotal role; however, the underlying mechanisms of this dysfunction remain poorly understood. Methods In the present study, we investigated the relationship between fibrinolytic products at admission and platelet function. We retrospectively analysed the data of patients with ATAAD from July 2020 to July 2025 at Delta Health Hospital (Shanghai, China). Pearson’s chi-square test was used to analyse the correlations between platelet aggregation and fibrinolysis parameters. The risk factors affecting postoperative in-hospital death and massive blood transfusion (MBT) were analysed using multivariate logistic regression analysis. Results A total of 154 patients with ATAAD, with a mean age of 52.40 ± 15.02 years, were selected for the study. In patients with ATAAD, the peripheral blood fibrinogen (FIB) concentration was negatively correlated with both adenosine diphosphate (ADP)-induced and arachidonic acid (AA)-induced platelet inhibition rates, whereas elevated D-dimer and fibrinogen degradation product (FDP) levels were associated with increased platelet inhibition rates in response to both agonists. We further found that fibrinolysis products derived from healthy human blood samples enhanced both ADP- and AA-induced platelet inhibition in a dose-dependent manner. Multivariate logistic regression analysis revealed elevated levels of D-dimer and FDP, along with increased ADP-induced and AA-induced platelet inhibition rates, as independent predictors of MBT and in-hospital major adverse events (MAEs). Conclusions In summary, our study elucidates the association between fibrinolysis products and platelet activity in patients with ATAAD and highlights the clinical value of platelet function monitoring in predicting perioperative transfusion requirements and patient prognosis.